The present invention relates to a medical instrument for use in rhinoplasty having a first rod-shaped element that comprises a distal portion intended to hold nasal cartilage of a nose side.
An instrument of this kind has been known, for example, from the German company catalogue of Karl Storz GmbH and Co., Tuttlingen, entitled xe2x80x9cSTORZxe2x80x94Karl Storz-Endoskopexe2x80x9d, Vol. xe2x80x9cEndoskope und Instrumente fxc3xcr HNOxe2x80x9d (endoscopes and instruments for ENT), 5th edition, 1996, page N 15 A.
Such an instrument is used in the field of rhinoplasty. In rhinoplasty, the structure of the nose is transformed, under functional and esthetic aspects, for example to reduce the size of the nose by manipulation of the nasal cartilage, or for removing any deformities, for example on the tip of the nose or the sides of the nose.
To permit corresponding operation on the nasal cartilage of both sides, for example, the latter must be completely exposed and presented in clearly visible form in order to permit the in part xe2x80x9cfiligreexe2x80x9d manipulations to be carried out on these elements. For this purpose, one initially makes a cut in the nasal cartilage, without, however, completely cutting off the nasal cartilage. Thereafter, the nasal cartilage must be pulled clear of the nasal cavity of the respective half of the nose, in order to be cleaned from any skin tissue and soft tissue. To permit the desired manipulations to be carried out on the nasal cartilage now exposed, the latter must be held in stationary condition in this advanced position in the area in front of the nostril.
The German company catalogue mentioned before shows under instrument number 478303 a rod-shaped element similar to a splint, which is suited for grasping by its distal end the nasal cartilage of one half of the nose, for pulling it out from the respective nasal cavity and for holding the nasal cartilage in that pulled-out position, for which purpose the nasal cartilage is loaded onto the level distal portion of the rod-shaped element. This is achieved by pushing the distal portion of the rod-shaped element below the nasal cartilage still supported in the nasal cavity.
However, this known instrument permits only one nasal cartilage to be held in the pulled-out position so that the nasal cartilage of the left and the right halves of the nose must be worked one after the other.
It is, however, of decisive importance for the success of any rhinoplasty measure that simultaneous and symmetrical working of the nasal cartilage of both sides must be possible, i.e. that the nasal cartilage of both sides must be exposed and presented in clearly visible fashion one beside the other, in order to permit the surgeon to compare the nasal cartilage of both sides continuously during the operation.
Now, in order to permit the nasal cartilage of both sides to be held in the pulled-out position one beside the other, one might consider to use two of the known instruments, one for the nasal cartilage of the left half of the nose, and one for the nasal cartilage of the right half of the nose. However, this would present the problem that both rod-shaped elements would have to be held by the surgeon or by an assistant, which would hinder the surgeon in his work, namely the manipulation of the nasal cartilage. Thus, the simultaneous use of two of the known instruments proves to be disadvantageous under aspects of maneuverability of such an instrument.
Now, it is the object of the present invention to improve an instrument of the before-mentioned kind and to provide a methode for presenting nasal cartilage so that it will be rendered possible to simultaneously present the nasal cartilage of both the left and the right halves of the nose with the aid of the instrument, which in addition can be handled with ease.
The invention solves this object with respect to the before-mentioned instrument by the fact that the instrument comprises a second rod-shaped element having a distal portion for holding nasal cartilage of the other side of the nose, and a fixing element which is detachably mounted on the first element and the second element and which mutually fixes the two elements one beside the other in approximately parallel alignment one relative to the other.
By providing two rod-shaped elements both the nasal cartilage of the left half of the nose and the nasal cartilage of the rigth half of the nose can now be simultaneously held in the pulled-out position one beside the other, whereby the nasal cartilage of both sides can be presented in clearly visible fashion so as to permit the surgeon to constantly compare the nasal cartilage of both sides during his manipulations on the nasal cartilage. The fixing element provided according to the invention now presents the particular advantage that the two rod-shaped elements, each of which supports the nasal cartilage of one side, can be fixed in position one relative to the other so that during operation, which usually is carried out with the patient lying on his back, two rod-shaped elements, being fixed by means of the fixing element, can be positioned, for example, on the patient""s chin or on a respiration mask. Thus, it is not necessary that the two rod-shaped elements be held by the surgeon or an assistant during the manipulations on the nasal cartilage, since the fixing element ensures that the two elements are sufficiently fixed in their positions. The surgeon, therefore, has his two hands free for carrying out the required manipulations on the nasal cartilage of both sides, and is not hindered by the close presence of an assistant, either. The fact that the fixing element can be mounted detachably on the first and the second elements provides the additional advantage that the first rod-shaped element can be separately used, with the fixing element initially detached, for picking up and pulling out the nasal cartilage, for example of the left half of the nose, whereafter the second rod-shaped element can be used separately in order to pick up and pull out the nasal cartilage of the right half of the nose, which operations can be carried out more easily with individual separate rod-shaped elements as provided herein according to a method for simultaneously presenting nasal cartilage of a left and a right half of a nose, according to the invention. Once the nasal cartilage of both sides has been loaded onto the respective rod-shaped elements, the two rod-shaped elements are fixed in their position one relative to the other by mounting the fixing element, whereafter the instrument can be deposited on the patient""s face, as mentioned before, with the nasal cartilage of both sides presented in clearly visible form for manipulation. Thus, handling of the instrument according to the invention is especially easy. Making the fixing element detachable provides the additional advantage that the rod-shaped elements can be used without the fixing element also for different purposes.
The object underlying the present invention is thus perfectly achieved.
According to a preferred embodiment, the distal portion of the first element and the distal portion of the second element are configured symmetrically one relative to the other.
This feature provides the advantage that the symmetrical presentation of the nasal cartilage of both sides is rendered possible, in connection with the fixing block, which further facilitates the symmetrical treatment of the nasal cartilage of both sides, which is so desirable for the success of the plastic operation.
In a further preferred embodiment the distal portion of the first element and the distal portion of the second element are provided on their upper surfaces with markings for improved orientation.
This feature provides the advantage that the markings, being constituted for example by a millimeter scale, permit the dimensions of the nasal cartilage of both sides to be compared more precisely, whereby precise symmetrical working of the nasal cartilage of both sides is guaranteed.
According to a preferred embodiment the fixing element is configured as a slip-on element that can be fitted from the proximal end of the elements.
This provides advantageously a connecting mechanism between the fixing elements and the rod-shaped elements that can be handled with special ease when the two rod-shaped elements are to be fixed one to the other after the nasal cartilage of both sides has been loaded on the respective elements. Sliding the fixing element onto the elements from their proximal ends provides the advantage that no forces acting transversely to the longitudinal direction of the elements must be applied when mounting the fixing element, which ensures that no undesirable leverage is exerted upon the loaded nasal cartilage of both sides by the rod-shaped elements being moved out of their orientation along their longitudinal axes.
It is further preferred in this connection if the fixing element has two longitudinally extending openings intended to receive proximal longitudinal portions of the elements.
It is an advantage of this arrangement that the fixing element embraces the proximal ends of the two rod-shaped elements over portions extending in longitudinal direction, whereby the two elements are fixed in position one beside the other with particular stability so that any tilting of the two elements out of their approximately parallel orientation one relative to the other is avoided.
It is further preferred in this connection if the fixing element comprises a block member in which the openings are provided in the form of grooves, the fixing element further comprising a cover that closes the grooves along their open long side.
This two-part embodiment of the fixing element is especially advantageous under aspects of manufacture since the grooves can be produced in the block member by a milling process. This allows the openings in the fixing element to be given a non-circular cross-portion, if desired, in order to allow the two elements to be positively received in case their proximal end portions also exhibit a non-circular cross-portion. The cover then advantageously closes the grooves along their open long sides so that the openings are laterally closed on all sides and safe fixing of the fixing element to the two elements is rendered possible.
The cover may be fixed to the block member, for example by welding. However, it is also preferred if the cover is detachably mounted on the block member.
This provides the advantage that any dirt gathering in the openings can be removed more easily with the cover detached, with improves the cleaning properties of the fixing element. In addition, this further provides the advantage that in case the elements should get canted in the fixing element so that they can no longer be easily withdrawn from the fixing element, the elements can be removed more easily after removal of the cover. The cover may be detachably mounted on the block member, for example by means of screws or by a snap-on arrangement.
According to a further preferred embodiment, the fixing element is configured as a slip-on element that can be slipped or slid onto the elements from a lateral side.
This, too, presents an advantageous solution for a connecting mechanism for mounting the fixing element on the two elements.
According to a further preferred embodiment, the fixing element can be mounted on the elements in a self-locking fashion.
It is an advantage of this arrangement that no additional measures, such as screws of the like, are required for mounting the fixing element on the two rod-shaped elements. In the case of the before-mentioned embodiment, where the fixing element is configured as a slip-on element that can be fitted from the proximal end, this may be realized for example by an elastic element, for example in the form of a bent leaf spring that locks the proximal longitudinal portions of the two rod-shaped elements in the openings by a clamping effect.
It is further preferred in this connection if the fixing element can be snap-locked on the two elements.
This also leads to an arrangement for fixing the fixing element on the two rod-shaped elements that can be handled with special ease, for example by providing an elastic detent in the openings of the fixing element, which snaps into a locking groove provided in the longitudinal portions of the two rod-shaped elements, received in the openings, when mounting the fixing element.
Further advantages are evident from the description and from the appended drawings.
It is understood that the features recited above and those yet to be explained below can be used not only in the respective combinations indicated, but also in other combinations or in isolation, without leaving the context of the present invention.